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Biomedical subjects

F H Edwards

Publications and source records attributed to F H Edwards.

At least 37 records · Page 2Linked to original sources
PubMed1994

Coronary artery bypass grafting: the Society of Thoracic Surgeons National Database experience.

The need for accurate risk assessment has become an indispensable element in the practice of cardiac surgery. The Society of Thoracic Surgeons National Cardiac Surgery Database allows subscribing institutions to perform sophisticated patient risk assessment using traditional statistical tools and a newly developed risk model of operative mortality. The database experience with isolated coronary artery bypass grafting has been studied most closely at this point and serves as the basis for this report. The approach to operative risk assessment is presented along with an analysis of important risk factors in the practice of coronary artery surgery from 1980 through 1990. The database contains records of 80,881 patients undergoing coronary artery bypass grafting in numerous institutions from 1980 through 1990. These records were used to conduct a detailed analysis of risk factors associated with coronary operations in this time interval and to present statistical methods used to formulate a risk equation that allows one to predict the probability of operative death. In the course of this decade, there were clearly defined trends showing a statistically significant increase in adverse patient risk factors. The risk model has proven to be a reliable tool for predicting the probability of operative death in an individual patient and may be valuable in both patient counseling and medical decision making. Large multi-institutional databases of this type are key ingredients of modern operative risk assessment. A database containing a broad national experience of this type can represent an aggregate experience that may well approximate a universally accepted standard of care.

Adult↗
PubMed1994

Impact of internal mammary artery conduits on operative mortality in coronary revascularization.

The long-term advantages of internal mammary artery (IMA) conduits in coronary artery bypass graft (CABG) procedures are widely recognized, but the immediate short-term impact of IMA grafts is not well defined. The purpose of this study was to investigate the influence of IMA conduits on CABG operative mortality (OM). A retrospective study of two groups of patients undergoing isolated CABG was performed. Patients having at least one IMA graft (group 1) were compared with those with only venous conduits (group 2). The patient population was taken from The Society of Thoracic Surgeons National Cardiac Surgery Database, which contains a broad multi-institutional experience. A total of 38,578 registered patients undergoing isolated CABG from 1987 through 1991 were studied. Of these, 18,614 patients had at least one IMA conduit (group 1), whereas 19,964 had CABG using entirely venous conduits (group 2). The OM for group 1 was 2.0% (365/18,614), whereas the mortality was 4.5% (903/19,964) for group 2 (p < 0.005). Patient subgroups were examined to determine if the improved OM associated with IMA grafting was present in these patient subsets. The population was broken down according to age, sex, ejection fraction, extent of coronary disease, and operative priority. For each subset, univariate analysis showed that group 1 OM was significantly less (p < 0.005) than the OM for group 2. Numerous combinations of these patient parameters were also analyzed. Group 1 patients had a significant (p < 0.05) improvement in OM in each combination except for patients more than 70 years of age requiring reoperations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Pediatric and adult thoracic trauma: age-related impact on presentation and outcome.

UNLABELLED: To assess the impact of age on presentation and outcome, 2,415 cases involving blunt and penetrating thoracic trauma over an 8-year period were reviewed retrospectively from a single level I trauma center. Of the 2,073 patients alive on arrival, 79 were 12 years of age or less (children), 137 were 13 to 17 years of age (adolescent), 1,742 were 18 to 59 years of age (adults), and 115 were 60 years of age or more (elderly). Chi-square analysis was performed relative to presentation (blunt versus penetrating), need for thoracotomy, and hospital mortality. Although blunt thoracic trauma comprised 64/79 of children (81%) and 90/115 of the elderly (78%), penetrating thoracic trauma was more common for adolescents 79/137 (58%) and adults 1013/1742 (58%) (p < 0.05). There was no significant difference in need for thoracotomy among the four age groups after blunt thoracic trauma. For penetrating trauma, however, there was a significantly higher incidence of thoracotomy in children as compared with the other three age groups (p < 0.05). IN CONCLUSION: (1) Blunt injuries comprised a greater proportion of thoracic trauma in children and the elderly. (2) In this series, children with penetrating thoracic trauma underwent thoracotomy more frequently. (3) Hospital mortality appeared to be increased for the elderly. (4) Analyses of pediatric thoracic trauma must separate children from adolescent age groups.

Adolescent↗
PubMed1994

Practical considerations in the management of large multiinstitutional databases.

Large multiinstitutional databases are excellent sources of information that provide clinically useful insight into the practice of cardiac surgery. Fully informed subscribers should be aware of the practical concerns associated with the management and interpretation of database results. During development of The Society of Thoracic Surgeons National Database, three such areas have become particularly important: the database population, the database quality, and the significance of results. Appreciation of the real and philosophical problems associated with these issues will allow for greater appreciation of the intricacies of the database and will enhance the users' ability to interpret information gained from the database.

Bias↗
PubMed1994

Profile of preoperative characteristics of patients having CABG over the past decade.

The Society of Thoracic Surgeons' National Cardiac Database was used to determine the changes in preoperative characteristics and the predicted and observed risk of operative mortality of patients undergoing coronary artery bypass grafting during the decade of 1984 to 1993. During this period, the data show an increase of 2.5 years in age and decreases of 3% both in incidence of male patients and in incidence of first operation. There was little change in the percentages of urgent/emergent procedures or mean left ventricular ejection fraction. There was a significant 17.5% decrease in the proportion of lowest risk patients (0% to 2.5% predicted mortality) from 61.1% to 43.6%. Although no change in the next higher risk group (> 2.5% to 5.0% predicted mortality) occurred, the higher risk groups showed increases of 6.2%, 9.1%, 1.4%, and 1.1% for the > 5% to 10%, > 10% to 20%, > 20% to 30%, and > 30% to 50% risk groups, respectively. Over the past 2 years, there have been no significant changes in the distribution of the risk groups. These data will provide a base for comparison of future endeavors to lower complication rates and cost of coronary artery bypass graft operations.

Coronary Artery Bypass↗
PubMed1993

Anomalous pulmonary venous drainage of the right lung.

An unusual case of anomalous drainage of the right lung is described. The right superior pulmonary vein drained into the superior vena cava, and the middle and lower pulmonary veins drained into the inferior vena cava. Repair was achieved by creating a pericardial baffle that drained the inferior vein and the orifice of the superior vena cava through a surgically created atrial septal defect. The superior vena cava was transected and the distal portion anastomosed to the right atrial appendage.

Anastomosis, Surgical↗
PubMed1993

Effect of internal mammary harvest on postoperative pain and pulmonary function.

Forty-three patients undergoing median sternotomy were evaluated for postoperative pain and pulmonary function. Group 1 (n = 26) had harvest of the internal mammary artery (IMA) and group 2 (n = 17) did not. Postoperative pain and pulmonary function were evaluated on the fifth postoperative day. Both groups showed a decrease in forced expiratory volume in 1 second (group 1, 44%; group 2, 39%), but there was no significant difference in the loss between the two groups (p = 0.32). Using a numeric rating scale, there was significant increase in postoperative pain in group 1 (group 1, 6.35; group 2, 3.82; p = 0.0002). There is a suggestion that internal mammary artery harvesting itself worsens postoperative pulmonary function tests, and this may be related to a significant increase in postoperative pain.

Adult↗
PubMed1993

Primary mediastinal masses. A comparison of adult and pediatric populations.

Since 1944 62 pediatric patients with primary cysts and tumors of the mediastinum have been operated on at our institution. We compared this group with 195 adult patients with similar diagnoses who were operated on during this period. Comparisons were made with regard to histologic type, location, presenting symptoms, physical findings, and surgical complications. We found significant increases in the prevalence of lymphoma in adults (41/195 versus 4/62, p < 0.05) and of neurogenic tumors in children (21/62 versus 24/195, p < 0.05). There were no significant differences in the prevalence of thymic tumors (51/195 versus 22/62), germ cell tumors (24/195 versus 4/62), and cysts (32/195 versus 15/62). There was no difference in the prevalence of symptomatic patients (99/195 versus 36/62). The prevalence of malignancy has increased in both groups since 1970 (2/28 versus 16/34 in children, p < 0.01; and 14/56 versus 69/139 in adults, p < 0.05). This is attributed to a rise in the prevalence of malignant neurogenic tumors in children and to an increase in the prevalence of lymphomas in adults. Tumor size, location, and the presence of symptoms were predictive of malignancy in the adult population but not in the pediatric population. No difference existed in mortality and morbidity between the two groups. All three pediatric deaths were directly related to loss of airway control as a result of mass effect from the tumor. Definite differences exist between the adult and pediatric populations with regard to mediastinal tumors. These differences need to be considered carefully when evaluating and planning treatment for a child with a mediastinal mass.

Adolescent↗
PubMed1993

Post-extubation non-cardiogenic pulmonary edema.

Non-cardiogenic pulmonary edema (NCPE) is a rare entity manifested by pulmonary edema with normal pulmonary arterial pressures. NCPE has been described in children and recently reported in adults. Onset is rapid and late recognition or inappropriate treatment may lead to a fatal outcome. Most adult cases have been attributed to laryngospasm and generation of a large negative intrathoracic pressure causing transcapillary filtration. The majority of reported adult cases were at risk for Upper Airway Obstruction (UAO). This report describes three young, active duty men who developed this entity following routine uncomplicated surgical procedures. Intubations were uncomplicated and fluid management appropriate. No patient had risk factors for UAO. Early extubation with respiratory attempts against a closed glottis may be etiology for this complication.

Adult↗
PubMed1992

Post-atherectomy coronary artery aneurysm.

A 52-year-old man underwent an uneventful directional atherectomy of the left anterior descending coronary artery. Four months after the procedure unstable angina developed and on angiogram an aneurysm of the left anterior descending coronary artery was noted. The patient underwent bypass of the left anterior descending coronary artery. An attempt to exclude the aneurysm resulted in hemodynamic compromise and was discontinued. Follow-up angiogram 2 months after operation showed the aneurysm to be smaller. The patient is doing well 6 months after operation.

Atherectomy, Coronary↗
PubMed1992

Surgical management of posteroseptal accessory atrioventricular pathways.

From October 1988 through January 1991, 22 consecutive patients with Wolff-Parkinson-White syndrome underwent surgical ablation of symptomatic accessory posteroseptal atrioventricular pathways at our institution. As our experience with posteroseptal tracts accumulated, we found that surgical technique was logically dictated by the presence of free wall tracts and the exact location of the posteroseptal tract. Accordingly, we developed an operative approach that involves the selective use of endocardial, epicardial, and cryoablation techniques depending on the anatomic location of accessory tracts. This selective approach allows one to exploit the advantages of each technique while minimizing associated disadvantages. There were 14 men and 8 women with an average age of 25 years (range, 19 to 39 years). All patients had symptomatic tachyarrhythmias caused by accessory atrioventricular pathway(s). Most required several antiarrhythmic medications and 17 (77%) had poor arrhythmia control despite maximal medical therapy. Twelve patients had two accessory pathways and 3 also had dual atrioventricular nodal pathways. There were no early or late deaths. In 2 patients, a delta wave associated with a free wall tract reappeared 3 to 5 days after the initial operation, necessitating a second operation which successfully eliminated the accessory tract. All posteroseptal tracts were successfully eliminated during the initial operation. All patients were relieved of symptoms and are now free of medical therapy. Each patient has undergone a postoperative electrophysiologic study which confirms the absence of posteroseptal accessory conduction. The selective approach has been totally successful in our hands and should prove useful to those interested in optimizing the efficiency of surgical procedures for Wolff-Parkinson-White syndrome.

Adult↗
PubMed1992

Vascular ring: does magnetic resonance imaging replace angiography?

The records of 21 patients who underwent operation for symptoms attributable to vascular ring were reviewed. The study covered 33 years, 1958 to 1991, and the mean follow-up was 6.8 years. The patients ranged from 7 days to 26 years old with a mean age of 2.9 years. Twenty patients were symptomatic. Symptoms were due to tracheal compression in 16 patients, esophageal compression in 2, and both causes in 2. During the first 30 years, chest roentgenography, barium swallow, and aortography constituted the diagnostic workup in the majority of the patients. During the last 3 years, magnetic resonance imaging replaced aortography. The surgical diagnosis included five variants of vascular ring. The surgical approach consisted of left thoracotomy in 19 patients and right thoracotomy in 2. These 2 had the diagnosis of right aortic arch with posterior left subclavian artery. In both instances, preoperative angiographic data determined the surgical approach. Barium swallow may be sufficient for the diagnosis of vascular ring; however, additional data are useful in determining the surgical approach. Magnetic resonance imaging can yield accurate data without subjecting the patient to the risks associated with angiography.

Adolescent↗
PubMed1991

Primary cysts and tumors of the mediastinum.

A retrospective analysis was performed on 230 patients with primary cysts and tumors of the mediastinum seen at our institution from January 1944 to April 1989. We divided these patients into two groups. Group 1 was seen before 1970 and group 2 was seen from January 1970 to April 1989. There was a significant increase in the prevalence of malignancy in group 2 (47.2% versus 17.1%; p less than 0.0001) due to an increase in the number of lymphomas (22.6% versus 3.5%; p less than 0.001) and malignant neurogenic tumors (6.8% versus 1.1%; p = 0.0528). There was a significant increase in the number of malignant tumors in the anterior (59.5% versus 30.9%; p = 0.0022) and paravertebral (28.5% versus 2.8%; p = 0.0027) compartments in group 2. More patients with these tumors were symptomatic in group 2 (63.6% versus 5%; p = 0.0422). There was an increase of ancillary diagnostic studies performed to evaluate these tumors (76.0% versus 34.5%; p = 0.0422). Logistic regression analysis identified date of presentation (p less than 0.005), symptoms (p less than 0.01), size (p less than 0.005), and the anterior mediastinal compartment (p less than 0.005) as preoperative predictors of malignancy. The surgical approach to these tumors included more median sternotomy (30.1% versus 10.7%; p = 0.0008), anterior mediastinotomy, and cervical mediastinoscopy in group 2 (1.1% versus 17.5%; p = 0.0002). Long-term results support surgical resection in benign lesions and an aggressive multimodality approach to malignant lesions.

Adolescent↗
PubMed1991

Primary cardiac valve tumors.

To investigate the characteristics of primary cardiac valve tumors, we retrospectively analyzed our multiinstitutional experience from 1932 through 1990. We encountered 56 valvular tumors in 53 patients. The average age of these patients was 52 years (range, 2 to 88 years) and 79% (42/53) were male. Symptoms were present in 38% (20/53) and were neurological in 15% (8/53). Four patients experienced sudden death. Each of the four valves was affected with approximately equal frequency: 16 aortic, 15 mitral, 13 pulmonary, and 12 tricuspid. All but four tumors were benign. The most common histological type was papillary fibroelastoma (41), followed by myxomas (5), fibromas (4), sarcomas (2), hamartoma (1), hemangioma (1), histiocytoma (1), and undifferentiated (1). Average tumor size was 1.15 cm (range, 3 mm to 7 cm), and the average size of fibroelastomas was 8 mm (range, 3 to 15 mm). Mitral valve tumors were more likely than aortic valve tumors to produce serious neurological symptoms or sudden death (8/15 versus 3/16; p less than 0.05). Six patients underwent echocardiography, and results were positive in each. All 6 underwent uncomplicated valve repair or replacement. Compared with a series of 407 nonvalvular tumors, cardiac valve tumors are more likely to occur in male patients (p less than 0.001) and adults (p less than 0.001). Valve tumors are also more commonly benign (p less than 0.001) and asymptomatic (p less than 0.001). These tumors demonstrate somewhat less aggressive behavior compared with non-valvular tumors, but their distinct propensity to produce serious clinical sequelae argues in favor of surgical resection for all cardiac valve tumors.

Female↗
PubMed1991

Current status of coronary artery operation in septuagenarians.

Previous reports of elderly patients undergoing coronary artery bypass grafting have not addressed the current era of aggressive percutaneous angioplasty and frequent urgent or emergent operation. To investigate this important subgroup of patients, we analyzed our recent coronary artery bypass grafting experience with patients 70 years of age or older. From January 1984 to January 1989, 121 consecutive patients in this age range underwent surgical revascularization at our institution. Overall in-hospital operative mortality (OM) was 7.4% (9/121), with 77.8% (7/9) of deaths due to cardiac causes. Serious postoperative morbidity occurred in 71.1% (86/121). Surgical priority was significantly correlated with operative mortality: for elective cases, the OM was 2.9% (2/68), but it was 8.6% (3/35) for urgent cases (p less than 0.05) and 22.2% (4/18) for emergency cases (p less than 0.05). Univariate analysis isolated the need for inotropic support, intraaortic balloon pump, reoperation, cardiopulmonary resuscitation, and emergency status as significant risk factors for OM (p less than 0.05). Multivariate stepwise logistic regression analysis identified the need for inotropic support, intravenous nitroglycerin, reoperative coronary artery bypass grafting, and hypertension as independently significant risk factors. A logistic risk equation developed from this population accurately modeled OM at the extremes of operative risk. Three (3.1%) of the 97 patients predicted to have less than 5% OM died, whereas all patients predicted by the model to have greater than 90% OM died. These results indicate that in spite of relatively high morbidity and mortality rates, elderly patients have a very acceptable operative risk in the current era of high-risk coronary artery bypass grafting. This is particularly true if elective revascularization is possible.

Aged↗
PubMed1991

Effect of lung contusion on pulmonary hemodynamics.

Our purpose was to examine changes in pulmonary hemodynamics for patients with pulmonary contusion. Pulmonary vascular resistance index (PVRI) and shunt fraction were calculated from standard measurements in 25 traumatized patients. The percent of lung volume injured, measured as air-space filling disease (ASF), was quantitated from computed tomograms using a previously described technique. The amount of reactive pulmonary vasoconstriction per unit of injury (PVRI/ASF) identified 3 groups of patients: 5 were reactors (PVRI/ASF greater than 15), 10 were weak-reactors (PVRI/ASF = 5 to 15), and 10 were nonreactors (PVRI/ASF less than 5). In the reactor group PVRI increased as the size of contusion (ASF) increased (r = 0.99). In weak-reactors PVRI also increased with the size of contusion (r = 0.93), but the slope was less pronounced. In both groups shunt fraction did not rise above 0.31. In the nonreactors, PVRI remained normal while shunt fraction increased with the extent of injury (r = 0.95). These results indicate that pulmonary vasoconstriction often occurs after pulmonary contusion. The vasoconstriction most probably represents a compensatory mechanism to limit perfusion of traumatized parenchyma, thereby minimizing increases in shunt fraction. Some patients (nonreactors) not demonstrating this response have unchecked increases in shunt fraction. This insight into the hemodynamic sequelae of pulmonary contusions may enhance our ability to provide optimal care for patients suffering from this injury.

Adolescent↗